Customer Service Senior Representative- Express Scripts- Remote

Delivers specific delegated Customer Service tasks assigned by a supervisor. Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, providers and/or others for information and assistance. Performs research to respond to inquiries and interprets policy provisions to determine most effective response. Mails or routes claim forms and supporting documentation to various units for final processing. Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, or complaints of moderate to substantial complexity. Completes day-to-day tasks without immediate supervision but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.

Responsibilities:
·        Work closely with pharmacist staff to coordinate clinical interventions.
·        Ensuring optimal client services, communicating with different departments, outreaching to prescribers offices, participating in periodic meetings, helping with assignment of interventions, measuring outcomes and reporting outcomes.
·        Delivers specific delegated clinical tasks assigned by the Clinical Operations supervisor
·        Receives requests by email, telephone, or in person regarding clinical interventions.
·        Responds to inquiries from adjusters, different departments and/or others for information and assistance.
·        Sorts progress notes and clinical documents to initiate interventions for pharmacy reviews.
·        Manages interventions utilizing SharePoint, Excel, Microsoft teams, myMatrixx portals and systems.
·        Position typically requires excellent interpersonal skills, ability to understand and interpret client requests.
·        Independently responds to inquiries, grievances or complaints of moderate to substantial complexity.
·        Completes day-to-day tasks without immediate supervision, but has ready access to advice from more experienced team members.
·        Tasks involve a degree of forward planning and anticipation of needs/issues.
·        Complete outbound phone calls to prescriber offices and pharmacies
·        Input and gather intervention metrics and report as required by the business

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.